Diabetic Ketoacidosis in Pregnancy: An Overview of Pathophysiology, Management, and Pregnancy Outcomes

Abstract

Diabetic ketoacidosis (DKA) is an obstetrical emergency that is associated with an elevated risk of adverse pregnancy outcomes. This includes pregnancy loss in up to 1 in 3 cases. Due to the normal metabolic changes that occur during pregnancy, females who are pregnant are more vulnerable to DKA, and it can occur at lesser than expected degrees of hyperglycaemia. Presenting symptoms can be non-specific and include nausea and vomiting, fatigue, polydipsia, and polyuria. DKA may be the first presentation of previously undiagnosed diabetes. Therefore, high index of suspicion, along with prompt diagnosis and management, is essential. The cornerstones of management include intravenous insulin, intravenous fluids, and electrolyte replacement. Treatment generally follows the principles for DKA management outside of pregnancy, with some additional considerations. Close maternal and fetal monitoring is essential, and intensive care unit admission is typically required to adequately achieve this goal. In all situations, a thorough investigation should occur to address the underlying cause of the DKA and prevent further episodes. This review article outlines the potential etiopathogenesis, clinical presentation, and management of DKA in pregnancy.

Pregnancy and diabetic ketoacidosis: fetal jeopardy and windows of opportunity

“…Published data on DKA in pregnancy are limited and mostly represented by case reports, case series or small cohorts in high income countries ( 9 , 10 , 32 – 35 ). In the literature, most DKA cases are mild and occur late in pregnancy, findings consistent with ours ( 10 , 14 , 15 , 32 , 35 , 36 ). Two of the larger case series of pregnancy-related DKA are Dhanasekaran et al.’s single- center study performed in Rochester, Minnesota and Diguisto et al.’s multi-center study from the United Kingdom (UK) ( 32 , 37 ).…”